Orobello P W, Park R I, Wetzel R C, Belcher L J, Naclerio R M
Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Int J Pediatr Otorhinolaryngol. 1991 Feb;21(1):51-8. doi: 10.1016/0165-5876(91)90059-k.
The use of inhalational anesthesia for insertion of tympanostomy tubes in children provides no postoperative pain relief. Our retrospective analysis of children following tympanostomy tube insertion previously had shown significant postoperative elevations of blood pressure and heart rate in over 70% of cases. These changes, along with behavioral findings and complaints of discomfort, are suggestive of pain. Phenol has been used in adults for local anesthesia during tympanostomy tube insertion. This study determined prospectively whether pain occurred postoperatively and whether phenol placed on the tympanic membrane just prior to myringotomy would reduce postoperative pain in children, as measured by behavioral and physiologic parameters. Results of a double-blind, randomized trial in 46 children showed that both the phenol-treated and the control groups demonstrated significant elevations in pain scores postoperatively (P = 0.0001), which then slowly diminished to baseline by 45 min to one hour. The phenol group had consistently higher pain scores than the non-phenol group (P less than 0.001). Possible reasons for these findings are discussed.
在儿童鼓膜造孔置管术中使用吸入性麻醉不能缓解术后疼痛。我们之前对鼓膜造孔置管术后儿童的回顾性分析显示，超过70%的病例术后血压和心率显著升高。这些变化，连同行为表现和不适主诉，提示存在疼痛。苯酚已用于成人鼓膜造孔置管术中的局部麻醉。本研究前瞻性地确定术后是否发生疼痛，以及在鼓膜切开术前将苯酚置于鼓膜上是否会减轻儿童术后疼痛，疼痛程度通过行为和生理参数来衡量。对46名儿童进行的双盲随机试验结果显示，苯酚治疗组和对照组术后疼痛评分均显著升高（P = 0.0001），然后在45分钟至1小时内缓慢降至基线水平。苯酚组的疼痛评分一直高于非苯酚组（P小于0.001）。文中讨论了这些发现的可能原因。
